News In this issue

News

Diversifying communication channels

but focusing on key messages on IPV ntroduction in Nepal

AMP Supports Human Resources for Immunization in Vietnam

Partnership betw the Chilean Infectious Diseases Society and the MoH launches

an online course on MR in Chile

Cold Chain Information System: An

innovative approach

WHO delivers tetanus toxoid vaccine to Ukraine

Supplemental immunization against measles and rubella continues in Azer-baijan

Registration now open for EPIVAC®

MIVA

2

2

3

3

4

4

5

Meetings / workshops

8th African Rotavirus Symposium

IAIM hosts the Inaugural Regional Meeting for Africa and the

Middle East

Third workshop for National Regulato-ry Authorities (NRAs) for vaccine in

the Western Pacific Region

National workshop on effective vaccine management assessment

National workshop on vaccine safety

signal detection

14th meeting of the European Technical

Advisory Group of Experts on Immun-ization (ETAGE)

Training workshop in preparation of rotavirus introduction in Tajikistan

Introducing HERMES Supply Chain Modeling to Mozambique: Workshop

Report

6

7

8

9

10

11

12

13

Resources 14-

16

Calendar 17-

18

Links 19

Philippines introduces the Inactivated Polio Vaccine (IPV) in its

routine immunization Programme Lois Privor-Dumm, International Vaccine Access Centre (IVAC)

In a landmark step to accelerate the global eradication of polio and help prevent a resur-

gence of the disease, the Philippines announced on

6 October 2014, the introduction of a supple-

mental dose of the injectable Inactivated Polio Vac-

cine (IPV) into its routine immunization pro-

gramme. The launch for the National Capital Re-

gion (NCR) took place on 6 October 2014 in the

city of Paranaque, part of Manila’s metropolitan

area and will gradually expand nationwide.

This major step, which is part of a worldwide

rollout of IPV across 126 countries by the end of

2015, puts the Philippines at the forefront of the

fight against Polio by becoming the first non-

GAVI country in Asia using an all oral polio vac-

cine (OPV) schedule to add IPV to its routine

immunization programne.

Until now, OPV has been the primary tool in the global polio eradication effort, and has

reduced the global incidence of the disease by more than 99 percent, thanks to its unique

ability to stop person-to-person spread of the virus. But new evidence now clearly

demonstrates that adding one dose of IPV to multiple doses of OPV is the most effective

method available to stop the virus and protect children.

The importance of the ceremony was marked by the presence of several health dignitaries

including the Secretary of Health, Enrique Ona, the Undersecretary of Health, Jeanette

Garin and the Assistant Secretary of Health Enrique Tayag among other high-ranking offi-

cials.

This launch was followed by a regional event on 24 October 2014, on World Polio Day, in

the city of Iloilo for region six situated in the Visayas.

The universal introduction of IPV is part of objective two of the Polio Eradication and

Endgame Strategic Plan 2013-2018, to strengthen immunization systems, withdraw OPV

and introduce IPV.

More information on objective 2 of Endgame Plan, focused on IPV introduction, OPV

withdrawal, and routine immunization strengthening, is available on a dedicated WHO

website.

Global Immunization News (GIN) October 2014

SUBSCRIBE NOW

Send an email to listserv@who.int

with the following text in the body of the email:

subscribe GLOBALIMMUNIZATIONNEWS

VIEW PREVIOUS EDITIONS

For previous editions of the GIN,

visit the GIN archive on the WHO website:

www.who.int/immunization/gin

You can click on the article you are

interested in and access it directly!

Right: Secretary of Health Enrique Ona

(center) and other health officials cele-

brating the launch of IPV in the Philip-

pines.

Page 2

Global Immunization News (GIN) October 2014

Diversifying communication channels but focusing on key messages on IPV

introduction in Nepal Hyung Joon Kim, UNICEF Nepal

On 18 September 2014, Nepal introduced one dose of Inactivated Poliomyeli-

tis Vaccine (IPV) at 14 weeks of age into its routine immunization schedule. It

became the first country in South Asia - and the first GAVI-supported country

in the world - to do so.

Despite Nepal’s high coverage of OPV3 (93%) and its polio free status, the plan

to introduce a new polio vaccine in routine immunization raised questions

about possible community concerns and non-acceptance of OPV.

With this in mind, the communication strategy developed for IPV introduction

in Nepal focused on three key messages: 1) One dose of IPV at 14 weeks in

addition to third dose of OPV; 2) Free of cost, safe and reliable vaccine against polio; and 3) IPV + OPV = Best

Protection for your child and community. This strategy was implemented through a number of communication

channels, to ensure maximum coverage and effectiveness.

IPV + OPV = Best Protection for Your Child and Community

The third message was repeatedly emphasized to mitigate the risk of caregivers thinking that OPV is now no long-

er necessary. This would potentially have a negative impact on routine immunization coverage of OPV and put

children at risk.

All three key messages were promoted through printed materials such as posters and banners, Public Service An-

nouncements on TV and radio and an orientation banner at health facility level designed specifically for Female

Community Health Volunteers (FCHVs). Several orientation meetings were held with Nepal Pediatric Society,

media professionals and policy makers to promote the three key messages.

While providing key information about the benefits of IPV, communication activities on IPV introduction in Nepal

strategically focused on emphasizing that both IPV and OPV are necessary for a healthy child, community and

country.

The first baby is immunized with

inactivated polio vaccine at the

launch ceremony in Kathmandu,

Nepal. Credit: Chandra Shekhar/

UNICEF

AMP Supports Human Resources for Immunization in Vietnam Alphonse Guyot and Dorothy Leab, Agence de Médecine Préventive (AMP)

Under the framework of Agence de Médecine Préventive’s (AMP) engagement to

improve the quality and equity of immunization services in Vietnam, AMP has

collaborated with the National Expanded Programme in Immunization (NEPI) in

Vietnam to develop the country’s first EPI website, which provides care givers

and health workers with knowledge and best practices on vaccines and immun-

ization.

The website addresses various topics highlighted by health facility immunization workers, especially the lack of

access to immunization procedures, regulations, guidelines, and standard operating procedures. The NEPI enables

the broad dissemination of this information as well as advocacy messages and information on vaccines and immun-

ization; users include health workers at all levels of the immunization system, and other relevant national and in-

ternational stakeholders. From January to October 2014, almost 150,000 people visited the NEPI website.

In addition, AMP has built the capacity of Vietnam’s NEPI to develop e-learning modules to train health staff using

an open learning management system (LMS) platform, customized to meet NEPI staff needs, with a focus on the

following topics: supportive supervision; preparation of an immunization station (e.g., health center); and planning

and budgeting.

After a pilot test of the e-learning modules in four provinces among 60 immunization staff, the NEPI is now devel-

oping a master plan to train immunization staff at regional, provincial, and district levels.

NEPI LMS platform

Page 3

Global Immunization News (GIN) October 2014

Partnership between the Chilean Infectious Diseases Society (SOCHINF) and the

Ministry of Health launches an online course on Measles and Rubella in Chile Doris Gallegos, Ministry of Health, Chile; Roberto Del Aguila, PAHO Chile; and Pamela Bravo, PAHO-Washington,

DC

Chile has documented that there has been no indigenous transmission of measles and rubella since 1993 and 2008,

respectively. Maintaining this elimination milestone requires that health professionals, particularly clinicians, commit to

promptly identifying and reporting measles/rubella cases that are imported or linked to importations. This can be ac-

complished through surveillance and the appropriate differential study of Febrile Rash Illnesses (FRI) to rule out or

confirm measles/rubella cases. Considering that FRI can have several causes and many physicians do not have the clini-

cal experience of diagnosing cases of measles and rubella, this is a complex challenge.

This situation has prompted the Chilean Infectious Diseases Society (SOCHINF), in collaboration with the Ministry of

Health and the Pan-American Health Organization (PAHO), to develop an online course to improve the reporting

and investigation of FRI. The course, titled "The challenge of the patient with a rash during measles and rubella elimi-

nation in America", is taught over two and a half months, is completely free and provides 50 hours for academic cred-

it. Approximately 160 doctors from all over the country are participating in the course, after it was actively promoted

by one of the members of the National Measles-Rubella Elimination Commission in Chile, Dr Katia Abarca.

The collaboration behind this online course will also help to create a strategic alliance between Chile’s Ministry of

Health, SOCHINF, and PAHO, to sustain the elimination of measles and rubella in Chile, and to support SOCHINF in

the training and awareness-building of physicians on measles-rubella surveillance.

To find out more information, please visit the SOCHINF website.

Cold Chain Information System: An innovative approach Ranjit Dhiman, UNICEF EAPRO and Ataur Rahman, UNICEF, Lao PDR

UNICEF along with the MoH and PATH is designing and implementing a SMS and web-based Cold Chain Information

System (CCIS) which will interface with the DHIS-2 platform in Lao PDR. It uses 30-day Electronic Temperature Log-

gers (30DTR) as a means of reporting the functioning of refrigerators on a monthly basis. The system aims to im-

prove health workers’ ability to monitor and manage fridge performance and bridge the gaps in information flowing

along the supply chain and improve management decision-making. The unique aspect of the CCIS is that it is very light

on user input on data submission and uses the data to trigger action at various levels of the system. Health workers

send just one SMS per month indicating alarms (or no alarms) with their fridges and stock balances of vaccines. If

there is an emergency (for example stock-out of vaccines or fridge failure), an “emergency action” SMS can be sent to

those people expected to take action. These messages build up the data history on performance.

The system aims to improve the vaccine and cold chain management functions of effective temperature monitoring,

stock management, equipment inventories, maintenance and contributes towards improving storage capacities by

pointing out the most/least effective equipment in use within the country supporting justification for type and quanti-

ties of equipment for future procurement. The system also improves the interaction between authorities and enables

supportive supervision.

With pilot testing over a period of one year, the system has been adapted to end-user requirements with 100% sub-

mission of data from health centers directly by SMS now being achieved. The system design of responses to generate

action combines well with the use of 30DTR and it is foreseen that the mechanism will be adopted in other countries.

The system is expected to be fully functional and implemented countrywide by the end of 2016 as the Ministry of

Health is expanding the system in a very cautious and well planned manner, and when the full interoperability with

DHIS2 is achieved.

Page 4

Global Immunization News (GIN) October 2014

WHO delivers tetanus toxoid vaccine to Ukraine Catharina de Kat-Reynen, WHO EURO

On 26 September 2014, WHO delivered a second tranche of medicine

to Kyiv. The shipment included 300 000 doses of tetanus toxoid (TT)

vaccine, which will cover Ukraine’s needs until the end of 2015. As of

25 September 2014, there were over 8,332 wounded in Ukraine, ac-

cording to WHO and the Office of the High Commissioner for Human

Rights (OHCHR).

“This shipment will address critical vaccination needs for the wounded,

in addition to everyday needs of both children and adults,” said Dr

Dorit Nitzan, WHO Representative in Ukraine. “Not only has the

conflict in the East increased the demand for the vaccine but, until this

shipment arrived, the country was virtually without TT vaccine sup-

plies.”

Many people have been injured as a result of the crisis in the Donbas

region. Open injuries have a potential for serious bacterial infections, including gas gangrene and tetanus; these in

turn may lead to long-term disabilities, chronic wound or bone infection and death. Wound infection is of particular

concern when injured patients do not receive immediate care or when large numbers of injured survivors exceed

the available capacity for trauma care.

Moreover, in emergencies affecting populations in which TT immunization levels are already low, as in Ukraine, spe-

cial attention should also be paid to preventing maternal and neonatal tetanus by immunizing women of childbearing

age and by improving the conditions of hygiene in which women give birth.

Supplemental immunization against measles and rubella continues in Azerbaijan Vusala Allahverdiyeva, WHO EURO

Azerbaijan has begun a second round of supplemental immunization activities against measles and rubella, in re-

sponse to an importation-related measles outbreak in 2013. The campaign is targeting 170 366 children and adoles-

cents aged 11 to 15 years.

An initial campaign to supplement routine immunization, conducted during

the European Immunization Week in April 2013, targeted 27 083 children

aged under ten years, who received measles–mumps–rubella (MMR) vaccina-

tion. For the second round, the Ministry of Health has procured 200 000

doses of WHO-prequalified measles–rubella (MR) vaccines.

This second round started on 14 October 2014 in the cities of Baku and

Sumgait, and the districts of Absheron and Agjabadi. Outreach vaccination

has been organized in every school in coordination with the Ministry of Edu-

cation. According to the Republican Center for Hygiene and Epidemiology,

144 565 children and adolescents (84.3% of the target group), were vac-

cinated from 14 to 27 October 2014 (inclusive).

In other cities and districts, selective MR vaccination will be provided at pol-

yclinics for the same age group.

Independent monitoring is being led by WHO with participation of the Ros-

tropovich–Vishnevskaya Foundation and UNICEF, and in close collaboration

with the Ministry of Health immunization programme.

From left: Dr Dorit Nitzan, WHO Repre-

sentative to Ukraine; Dr Olga Bogomolets,

Advisor to the President; and Dr Vasyl Laso-

ryshynets, Deputy Minister of Health of

Ukraine, explain the importance of a shipment

of tetanus toxoid vaccine. Credit: WHO.

Vaccination against measles and rubella

in Baku, Azerbaijan, 14 October 2014.

Credit: WHO.

Registration now open for EPIVAC® Masters in Vaccinology and Management

(MIVA) Vitalien Adoukonou, Aristide Aplogan and Marjorie Nicol, Agence de Médecine Préventive (AMP)

The Agence de Médecine Préventive (AMP), the Félix Hou-

phouët-Boigny University (UFHB), the University of Abomey-

Calavi (Benin), the University of Lomé (Togo), the Polytechnic

University of Bobo-Dioulasso (Burkina Faso), and the Paris

Dauphine University (France) have opened registration for

the new International Master two in Applied Vaccinology

(MIVA) and the Master two in Economics and Management of

Public Health in Developing Countries (Master 241).

Both masters are delivered as part of EPIVAC®, a one-year on

-the-job training programne in applied vaccinology and manage-

ment for district medical officers in 11 Francophone sub-

Saharan African countries: Benin, Burkina Faso, Cameroon,

Central African Republic, Ivory Coast, Guinea, Mali, Mauritania, Niger, Senegal, and Togo.

To be eligible, candidates must have a Master One, a graduate degree, or certificate in public health, economics, or

a related field.

The classroom-learning phase common to both masters is scheduled from 26 January 2015 to 22 February 2015 at

the Regional Institute of Public Health (IRSP) in Ouidah, Benin. It will be followed by distance learning and on-site

tutoring, leading to the development of an operational research thesis that will be defended in front of an interna-

tional jury. Depending on the field of specialization chosen, participants will either receive the MIVA or Master

241 degree.

Supported by numerous partners including the World Health Organization (WHO), the West African Health Or-

ganization (WAHO), the United Nations Children’s Fund (UNICEF), Sanofi Pasteur, Gavi, and governments of

partner countries, EPIVAC aims to improve the performance of immunization services in Africa by strengthening

the technical and managerial skills of health professionals.

The Master 241 has been implemented since 2009 and is the continuation of the inter-university diploma of the

same name developed in 2002. The MIVA is now in its first year.

Global Immunization News (GIN) October 2014

Page 5

Global Immunization News (GIN) October 2014

Page 6

8th African Rotavirus Symposium

Roma Chilengi and Cheryl Rudd, Centre for Infectious Disease Research in Zambia

Location: Livingstone, Zambia

Date: 12-13 June 2014

Participants: 133 participants from 35 countries including rota-

virus scientists, clinicians, individuals working on la-

boratory surveillance work, national immunization

programmes officials, pharmaceutical industry and

academia.

Purpose: It is a gathering of leading rotavirus researchers and

scientists from across Africa that address current

research results and review current global epidemio-

logical trends. With the increasing number of coun-

tries introducing rotavirus immunisations, this sym-

posium was an important opportunity to share coun-

try experiences in introducing rotavirus vaccines into

country Expanded Programme on Immunisation pro-

grammes and to provide a platform for networking

for research, academia, lessons learnt, and career

growth.

Back row (Left to Right): Umesh Parashar, U.S.

Centers for Disease Control and Prevention,

Evans Mpabalwani, University Teaching Hospital,

Zambia, Duncan Steele Bill and Melinda Gates

Foundation, Roma Chilengi, Centre for Infectious

Disease Research in Zambia, George Ar-

mah, West African Regional Rotavirus Reference

Laboratory, Ghana, Cheryl Rudd, Centre for

Infectious Disease Research in Zambia.

Front Row (Left to Right): Penelope Kalesha-

Masumba, Ministry of Community Development,

Mother and Child Health, Jason Mwenda, World

Health Organization/AFRO, South Africa, the

Minister is the Honourable Minister Emerine

Kabanshi from the Ministry of Community Devel-

opment, Mother and Child Health, Roger Glass,

U.S. National Institutes of Health.

Details: Key topics discussed included disease burden and rotavirus epidemiology, strain diversity, and

emerging surveillance results from African Countries, current and future vaccines, vaccine intro-

duction and impact studies and global perspectives with interest to Africa. The symposium was

officiated by the Honourable Minister of Community Development, Mother and Child Health in

Zambia, leading to the keynote address by Dr Roger Glass, who gave a detailed discourse of the

history of African Rotavirus Network and rotavirus research. Surveillance reports pointed to the

wide diversity of circulating strains including predominant rotavirus genotypes G1P[8], G9P[8],

G2P[4], G2P[6], G1P[6] and G12P[8]. 22 African countries have now introduced the rotavirus

vaccine into their national immunisation schedules. Experiences on vaccine introduction were

shared by Mali, Malawi and Zambia. Post vaccine introduction impact data were shared by Ghana,

Rwanda and Botswana and a cost effectiveness analysis was presented for Zambia.

Overall, the symposium highlighted the mass uptake and experiences from across the continent

and the importance of having a forum to focus on rotavirus. The last session of the day provided a

highly interactive discussion on what needs to be done to enhance advocacy for rotavirus work in

Africa.

Meetings/Workshops

Global Immunization News (GIN) October 2014

Page 7

International Association of Immunization Managers (IAIM) hosts the Inaugural

Regional Meeting for Africa and the Middle East

Peter Carrasco, Sabin Vaccine Institute

Location: Durban, South Africa

Date: 25-26 September 2014

Participants: Fifty members of the International Association of

Immunization Managers from across the Middle East,

North Africa and Sub-Saharan Africa.

Purpose: To share with one another their experiences and

challenges in managing national immunization pro-

grams and also to begin shaping their Association.

Participants engaged in networking and breakout

sessions to exchange best practices and lessons

learned in order to improve the impact of their pro-

grammes.

Participants at the Inaugural Regional Meeting for

Africa and the Middle East

Details: “The inaugural meeting is a notable milestone for immunization programs and indeed history in the making.

For the first time, immunization managers have their own association to exchange their experiences and share

knowledge on management issues that are important for organizing and implementing successful vaccination

programmes,” said Dr K. O. Antwi-Agyei, immediate past national program manager of Ghana’s Ex-

panded Programme on Immunization (EPI) and member of IAIM’s ad hoc Governing Council.

Dr Serge Dali, Researcher at the Institut National de Santé Publique (INSP) in Côte d'Ivoire stated:

"IAIM’s approach is unique in the way it brings together all immunization managers in a single network

to share best practices and experiences […] this will impact in a positive manner the burden of vac-

cine preventable diseases for the coming years, in particular in the low and middle income countries."

Presentations and discussions focused on the key role of immunization managers, as well as core

competencies of managers, case studies of successful management decision-making, and the use of

data analysis.

The full proceedings of the meeting will soon be available at the IAIM website and sent to all IAIM members.

More information on IAIM is available at this link.

Global Immunization News (GIN) October 2014

Page 8

Third workshop for National Regulatory Authorities (NRAs) for vaccine in the

Western Pacific Region

Jinho Shin, WHO Regional Office for the Western Pacific; Md. Shafiqul Hossain, WHO Office for Cambodia; and

Lahouari Belgharbi, WHO Headquarters

Location: Manila, Philippines

Date: 17-19 September 2014

Participants: Thirty participants representing eleven countries

(Australia, Cambodia, Fiji, Japan, Korea (Rep.), Lao

PDR, Malaysia, Mongolia, Papua New Guinea, the

Philippines, and Viet Nam), Japan International Coop-

eration Agency.

Purpose: To review and update the status of implementing the

work plan of the Regional Alliance for NRAs for

Vaccines and future directions to support strength-

ening vaccine regulatory capacity in the Western

Pacific; discuss and agree on a proposed plan for five

working groups recently formed by the Regional

Alliance Steering Committee to support implement-

ing the institutional development plan in Western

Pacific Member States; and strengthen and align the

work of four WHO collaborating centers in the area

of biological standardization in the Western Pacific

with the work of the Regional Alliance for NRAs for

Vaccines.

Participants at the 3rd workshop for NRAs for

vaccines in the WPR

Details: Following the First WHO NRA Strategic Forum, held in May 2011, in Bangkok, Thailand, WHO

Western Pacific Regional Office convened the First Workshop for National Regulatory Authorities

(NRAs) for Vaccines in Seoul, Republic of Korea, in November 2011. A task force committee comprised of representatives of the NRAs of Australia, China, Japan and

the Republic of Korea developed a concept paper, a road map and a work plan to establish a re-

gional NRA alliance for vaccines. The alliance was officially launched at the second workshop in

March 2013 in Manila, Philippines. The third workshop was held from 17-19 September 2014 in

Manila, Philippines. The participants noted the update of the concept paper on the Regional Alli-

ance for NRAs for Vaccines in the Western Pacific Region that underpins formulating governance

and working groups. The participants welcomed the Regional Director for having issued a letter to all Member States of

the Region which reaffirmed the official launch of the regional NRA alliance. The participants dis-

cussed regional priorities for working group activities in five areas including regulatory system

strengthening, marketing authorization and licensing activities, lot release and laboratory testing,

vaccine safety surveillance, and international collaboration. Details of priority areas will be published in the meeting report. Four Member States (Cambodia,

Malaysia, Philippines, Viet Nam) which had gone through validation of NRA self-assessment in 2013

-14 presented their progress on implementing Institutional Development Plan (IDP) in detail. In

addition, four Member States (Fiji, Lao PDR, Mongolia, Papua New Guinea) reported their main

challenges in implementing IDP, e.g. including limited financial, human resources and expertise in

many areas of NRA systems and functions. The secretariat agreed on global and regional joint

training plan to assist Member States in implementing IDP 2015 as immediate follow-up.

Global Immunization News (GIN) October 2014

Page 9

National workshop on effective vaccine management assessment

Souleymane Kone and Shuyan Zuo, WHO Headquarters, Hailu Kenea and Wang Xiaojun, UNICEF

Location: Beijing, China

Date: 13-16 October, 2014

Participants: 23 Participants representing EPI pro-

gramme at China CDC and eight provinc-

es: Beijing, Hubei, Gansu, Tianjin, Shan-

dong, Shanghai, Xinjiang, Zhejiang. It was

facilitated by two staff from UNICEF and

three from WHO/HQ and China country

office, and one WHO consultant.

Group photo from participants in the EVM assessment

workshop

Purpose: To train a group on how to conduct a systematic review of immunization supply chain using the EVM

assessment tools and develop an evidence-based improvement plan, including policy, standard opera-

tional procedures through a systematic assessment.

Details: The EVM Assessment is a diagnostics tool for assessing the quality of a country’s vaccine supply chain.

A workshop on EVM assessment was convened on 13 to 16 October prior to the field surveys in two

provinces with expected outcomes of understanding of the cold chain status in the surveyed geo-

graphic areas, identification of programme gaps for improvement including policy and SoP from system

perspective, introduction of quality management principle into EPI programme and introduction of

method/tool of EVM into EPI programme. The methodology of the training workshop includes presentations, discussions and group work exer-

cise for the following areas in the EVM: questioners, hands-on the EVM assessment tool, and field vis-

its to four health facilities, hands-on data entry, analysis and presentation. The participants showed their satisfaction on the contents of this training which they found relevant

to their work areas. Field survey in two pilot provinces was conducted in the week of 20 October

2014 using EVM tool. Expand assessment in more provinces will be scheduled based on the assess-

ment report and lessons learned in the pilot.

Global Immunization News (GIN) October 2014

Page 10

National workshop on vaccine safety signal detection

Ananda Amarasinghe, Madhav Ram Balakrishnan and Shuyan Zuo, WHO WPRO

Location: Beijing, China

Date: 8-10 October, 2014

Participants: 33 participants representing the China national regu-

latory authority and EPI programme and 17 provinc-

es. Sessions were facilitated by two consultants from

US Center for Disease Control and Prevention, and

three from WHO/HQ, WPRO and China Country

Office.

Purpose: To improve the technical capacity of staff in vaccine

safety signal detection, validation and appropriate

response.

Group photo from participants in the workshop

on vaccine safety signal detection

Details: Both the China Food and Drug Administration (CFDA) and the National Health and Family Plan-

ning Commission (NHFPC) are facing greater demands for patient welfare and safety. Providing safe

and effective vaccines necessitate higher standards of vaccine safety monitoring, data validation,

analysis and signal detection through pharmacovigilance. This was facilitated through a workshop on

methods and practices on 8-10 October 2014 in Beijing China. The methodology included short presentations, case studies in small group and plenary discussions.

The presentations introduced included: an introduction to signal detection, framework for the eval-

uation of spontaneous reports, stratification by batch, age, gender for further screening, case defini-

tions for signal detection, data mining including data sources, mining tools, applications and parame-

ter settings, and signal verification and response. Participants enhanced their skills through three

case studies: increasing AEFIs and disease background rate, hepatitis A vaccine and anaphylaxis and

rotavirus vaccine and intussusception. Workshop materials are available at WHO/WPRO sharepoint. The workshop participants will be resource persons to organize cascade trainings and expand train-

ings in other provinces China.

Global Immunization News (GIN) October 2014

Page 11

14th meeting of the European Technical Advisory Group of Experts on

Immunization (ETAGE)

Catharina de Kat-Reynen, WHO EURO

Location: Copenhagen, Denmark

Date: 8-9 September 2014

Participants: ETAGE members and representatives of ECDC,

the European Commission, GAVI Alliance, SIVAC

Initiative, UNICEF, SAGE, NITAGs from Albania,

Armenia, Azerbaijan, Georgia, Romania, the for-

mer Yugoslav Republic of Macedonia and Ukraine.

Purpose: ETAGE provides guidance to the WHO Regional

Office for Europe on immunization-related activi-

ties and developments in the European Region. In

the coming years, this guidance will support imple-

mentation of the European Vaccine Action Plan

2015-2020 (EVAP), which was adopted by all Mem-

ber States in September 2014.

Group photo from participants in the 14th meeting of

the ETAGE. Credit: WHO.

Details: While applauding progress achieved over the past year in some areas, such as introduction of new

vaccines and establishment of additional national immunization advisory groups (NITAGs) (now pre-

sent in 43 out of 53 Member States of the European Region), ETAGE also voiced concern about ongo-

ing outbreaks of measles and rubella that threaten the 2015 elimination target for the Re-

gion; persistent immunity gaps in some population groups; and inconsistent quality and availability of

disease surveillance data. Other issues discussed at the ETAGE meeting included: progress in introduction of inactivated polio

vaccine (IPV) and planning for the transition from trivalent to bivalent oral polio vaccine (OPV), both

as part of the Polio Endgame Strategy; establishment of a regional goal for hepatitis B control; findings

of SAGE working group on pertussis vaccine; upcoming introduction of human papillomavirus (HPV),

rotavirus and pneumococcal (PCV) vaccines into the national immunization schedules of various Mem-

ber States; further establishment and capacity building of NITAGs; further roll-out and evaluation of

the Tailoring Immunization Programmes (TIP) approach to reach underserved populations; developing

strategies for adult immunization; data collection, reporting and management at all administrative lev-

els; addressing vaccine hesitancy; response to the Ebola crisis and potential availability of an Ebola vac-

cine.

Global Immunization News (GIN) October 2014

Page 12

Training workshop in preparation of rotavirus introduction in Tajikistan

Catharina de Kat-Reynen, WHO EURO

Location: Dushanbe, Tajikistan

Date: 17 September 2014

Participants: 35 immunization programme staff based in Dushanbe

Purpose: To build a cadre of specially trained clinicians at na-

tional level who can lead subsequent cascade trainings

in all regions of Tajikistan in September and October

2014.

National clinicians at training the trainers

course on rotavirus epidemiology and vaccine,

17 September 2014, Dushanbe, Tajikistan.

Credit: WHO.

Details: With support from the GAVI Alliance, Tajikistan will in January 2015 become the 14th Member

State in the WHO European Region to introduce rotavirus vaccine into its routine immunization

schedule. This step will significantly decrease morbidity and mortality caused by this disease in the

country. The training of trainers workshop was conducted with WHO support by the Republican Immun-

ization Center as part of nationwide preparations for rotavirus introduction. To assist the future

trainers, it provided evidence for introduction of rotavirus vaccine; explained rotavirus epidemiol-

ogy and the benefits of rotavirus vaccination for young infants; outlined vaccine administration,

contraindications, precautions and potential adverse reactions; presented a comprehensive strate-

gy to control diarrhoeal diseases.

National conference Alongside this effort, a national conference was organized on 30 October 2014 for medical acade-

micians and clinical specialists to facilitate their understanding of and support for rotavirus intro-

duction. Consisting of both teachers of future medical workers and practitioners, this group is

considered to be particularly influential in promoting vaccine uptake. Representatives from Armenia and WHO/Europe will also be present to share the experiences

and lessons learnt of other countries that have already introduced the vaccine.

Global Immunization News (GIN) October 2014

Page 13

Introducing HERMES Supply Chain Modeling to Mozambique: Workshop Report

Wendy Prosser, VillageReach and Shawn T. Brown, HERMES Logistics Modeling Team

Location: Maputo, Mozambique

Date: 29 September – 03 October 2014

Participants: Fifteen participants from the Ministry of Health

(MOH), Provincial Directorates of Health, UNICEF,

World Health Organization (WHO), University of

Eduardo Mondlane, Village Reach, and the HERMES

Logistics Modeling Team

Purpose: To develop a local team of experts with an under-

standing of the HERMES modeling tool through

practical hands-on training and able to interpret

results to improve vaccine delivery systems.

Peer-to-peer learning on HERMES

Details: Computer modeling a complex distribution system can assist in its evaluation, design and operations

for improving efficiency and effectiveness of immunization programmes. As part of an MOH decision

to pilot HERMES modeling in two provinces, the workshop introduced participants to the concept of

modeling and system design and provided them hands-on training with the user-friendly interface of

the HERMES modeling software. After initial presentations on the concept of modeling and the HERMES tool, the group installed the

user-friendly interface on their own laptops and began to learn how to build and run their own mod-

els, examine different scenarios for the vaccine supply chain, and interpret logistics and costing out-

comes from modeling results. Through the model-inspired brainstorming, participants identified several scenarios to model: 1) multi

-tiered system with health workers fetching vaccines from the district level; 2) following transport

loops with level jumping for direct delivery to health facilities; 3) using different delivery intervals of

one month, six weeks, or two months. Additionally, the different scenarios were modeled with the

introduction of new vaccines planned for the country (Rotavirus, HPV, IPV, and MSD). Initial results for one province indicated the logistics costs per dose are halved when using transport

loops and vaccine availability increases at the health center level. The model also showed that the

country will experience bottlenecks at the national and provincial levels with the introduction of new

vaccines. The local expert team will continue to refine the models to present results at the national EPI meeting

in December.

For more information about the HERMES Logistics Modeling Team, and for Village Reach.

Resources

Immunogenicity and safety of tetanus toxoid vaccine in Controlled Temperature

Chain (CTC) Aitana Juan-Giner, Epicentre

The results of a study conducted by Epicentre/Médecins Sans Frontières (MSF) assessing the immunogenicity and

safety of a tetanus toxoid vaccine have been recently published in Vaccine.1

The study was conducted in collaboration with Project Optimize, the Belgian Institute of Public Health (WIV-ISP)

and the Ministry of Health of Chad. A cluster randomized, non-inferiority trial was conducted in Moïssala district,

Chad, between December 2012 and March 2013. Prior to the study, stability indicator parameters of TT kept in

the controlled temperature cold (CTC) were shown to meet international requirements after exposure of vac-

cines in the study area to temperatures between 24.6 and 40.1°C (mean 31.2C°) for 30 days. Women aged 14-49

years, eligible for TT vaccination and with a history of ≤1 TT dose were allocated to CTC or standard cold chain

(SCC). Participants received two TT doses 4 weeks apart. Tetanus antibody titers were measured using standard

ELISA at inclusion and 4 weeks post-TT2. Primary outcome measures were post-vaccination seroconversion and

fold-increase in geometric mean concentrations (GMC).

A total of 2,128 women (CTC=1,068; SCC=1,060) participated in the study. Seroconversion was reached by

>95% of participants in the CTC and cold chain groups; upper 95%CI of the difference was 5.6%. Increases in

GMC were over 4-fold; upper 95%CI of GMC ratio was 1.36 in the adjusted analysis. Few adverse events were

recorded.

This study demonstrates that TT can be used in CTC without a significant loss of vaccine effectiveness. The use of

TT in CTC could facilitate the implementation of Supplementary Immunization Activities (SIAs) targeting high-risk

populations living in remote and hard to reach areas.

1In press: Juan-Giner A, et al. A cluster randomized non-inferiority trial on the immunogenicity and safety of teta-

nus toxoid vaccine kept in controlled temperature chain compared to cold chain. Vaccine (2014)

Handling of Multi-dose Vaccine Vials after Opening

WHO Policy Statement: Multi-dose Vial Policy (MDVP): 2014 Revision WHO/IVB/14.07

This document presents WHO’s official position with respect to how multi-dose vials of

vaccines should be handled once opened, including the specific conditions that warrant im-

mediate disposal, use within a maximum of six hours, and the criteria allowing for an opened

vial to be can be kept and used for up to 28 days after opening. The policy statement fur-

ther outlines conditions under which the MDVP can be implemented safely, including, but

not limited to, adherence to good immunization practices.

Manipulation des Flacons de Vaccin Multidoses Entamés

Déclaration de politique générale de l’OMS : La politique relative aux flacons mul-

tidoses : Revision 2014 WHO/IVB/14.07F

Ce document présente la position officielle de l'OMS en ce qui concerne la manipulation cor-

recte des flacons de vaccin multidoses une fois ouvert, y compris les conditions particulières

qui justifient une élimination immédiate, utilisation dans un délai maximum de six heures, et

les critères permettant un flacon ouvert d’être conservé et utilisé jusqu'à 28 jours après ou-

verture. La déclaration décrit en outre les conditions dans lesquelles cette politique peut être

appliquée sans risque, y compris, mais sans s’y limiter, le respect des bonnes pratiques de vac-

cination.

Global Immunization News (GIN) October 2014

Page 14

Global Immunization News (GIN) October 2014

Page 15

Principles and considerations for adding a vaccine to a national immunization

programme - From decision to implementation and monitoring now available in

Spanish and Russian

This document reviews the principles and issues to be considered when making decisions

about and planning the introduction of a new vaccine into national immunization programs.

The document also highlights ways to use the opportunity provided by the introduction of the

new vaccine to strengthen immunization and health systems. For more detailed information

about a specific vaccine or aspect of immunization, decision-makers and planners should con-

sult vaccine-specific position papers, vaccine-specific introduction guidance and other tools

developed by WHO, UNICEF and other partners. This resource document provides links to

many of these references and tools.

Immunization supply chain and logistics - A neglected but essential system for

national immunization programmes. A CAll-TO-ACTION (WHO/IVB/14.05)

La chaîne d'approvisionnement en vaccins et la logistique - un système négligé bien

qu'essentiel pour les programmes nationaux de vaccination- APPEL A L’ACTION

(WHO/IVB/14.05F)

In this Call-to-Action, the WHO Immunization Practices Advisory Committee (IPAC) ad-

vocates greater action by both national programmes and the global immunization commu-

nity to strengthen Immunization Supply Chain and Logistics. This Call-to-Action was ap-

proved by IPAC in October 2013 and endorsed by the WHO Strategic Advisory Group of

Experts (SAGE) on Immunization in April 2013.

In response to a rapidly changing and increasingly complex vaccination landscape where

existing Immunization Supply Chain and Logistics (ISCL) systems are not keeping pace, the

IPAC calls on national immunization programmes to measure, monitor and invest in their

ISCL systems, and to plan and implement improvements. In addition, the IPAC calls on the

global community of partners to increase awareness and investment, to harmonize ISCL

silos, to address ISCL when formulating immunization recommendations, and to identify

and resolve knowledge gaps. The short Call-to-Action document provides some background evidence and proposes

specific strategies.

Progress of GVAP indicators against immunization targets

The Global Vaccine Action Plan (GVAP) sets out an array of targets for a world in which all individuals and communi-

ties enjoy lives free from vaccine-preventable diseases.

As requested by Member States at the World Health Assembly in 2012, an annual review of the progress with the

implementation of the GVAP goals and indicators is done by the Strategic Advisory Group of Experts (SAGE), based

on a technical report prepared by the GVAP Secretariat (available on WHO GVAP web page).

To facilitate the exploration of the data, some data visualizations that measure progress against the goals and strate-

gic objectives of the Global Vaccine Action Plan (GVAP) have been made available on the TechNet-21.org website.

You can share your opinions or ask questions about these visualizations on the TechNet-21.org forum.

The visualizations were created by Thomas Cherian, Laure Dumolard, David Oh, Kamel Senouci and Daniela Urfer

from data available in the public domain.

Resources

Revised WHO position on human papillomavirus vaccines In an updated position paper published today, WHO revised the num-

ber of doses recommended for human papillomavirus (HPV) vaccines

for different age groups.

WHO reiterates its recommendation that HPV vaccines should be in-

cluded in national immunization programmes, provided that: prevention

of cervical cancer and other HPV-related diseases constitutes a public

health priority; vaccine introduction is programmatically feasible; sus-

tainable financing can be secured; and the cost-effectiveness of vaccina-

tion strategies in the country or region is considered.

Read the updated HPV vaccines position paper.

A new look for PATH's Vaccine Resource Library Allison Clifford, PATH

PATH’s Vaccine Resource Library (VRL) has debuted a brand-new look and

mobile-friendly design, taking the site to a new level of user-friendliness. The

new look and feel enhances the site’s accessibility and features many engaging

new photos.

The VRL prides itself on providing high-quality, scientifically accurate re-

sources on a variety of diseases, vaccines, and immunization topics that are

addressed by PATH’s work. Created in 1998 as part of PATH’s seminal Chil-

dren’s Vaccine Program, it has evolved into a well-respected, centralized re-

pository for key global immunization resources. VRL users will be pleased to

see that what has not changed with the redesign is the extensive database of

more than 1,500 high-quality, scientifically accurate materials.

Check out the updated website.

Global Immunization News (GIN) October 2014

Page 16

Global Immunization News (GIN) October 2014

Page 17

Calendar 2014

November

3-7 64th Session of the WHO Regional Committee for Africa Cotonou, Benin

10-12 EURO Regional Verification Commission (RVC) for Measles and Rubella

Elimination

Copenhagen, Denmark

10-21 GAVI Independent Review Committee (IRC) Applications Review Commit-

tee

Geneva, Switzerland

11-13 AFRO East & South GAVI Sub-Regional Workshop group meeting Antananarivo, Madagascar

11-13 Meeting on Using Information and Communication Technology (ICT) to

improve immunization programmes

Istanbul, Turkey

17-18 Rotavirus Technical Working Group LabNet Meeting Rio de Janeiro, Brasil

17-20 28th Intercountry Meeting of National Managers of the Expanded Pro-

gramme on Immunization

Amman, Jordan

22-25 15th Intercountry Meeting on Measles/Rubella Control and Elimination Amman, Jordan

28 EURO Regional Working Group Copenhagen, Denmark (?)

December

3-4 Global Advisory Committee on Vaccine Safety (GACVS) meeting Geneva, Switzerland

8-12 Vaccine-Preventable Diseases Laboratory Network Meeting Manila, Philippines

9-10 SEARO Regional Working Group on New Vaccines Introduction and

Health Systems Strengthening

Myanmar

10-11 GAVI Board Meeting Geneva, Switzerland

2015

January

26-3 Executive Board Geneva, Switzerland

27 GAVI Pledging Conference TBD

30 European Technical Advisory Group of Experts on Immunization (ETAGE)

and Extraordinary TAG Meeting

Copenhagen, Denmark (?)

February

16-20 cMYP Training Workshop Geneva, Switzerland

March

16-27 GAVI Independent Review Committee (IRC) for new proposals Geneva, Switzerland

April

14-16 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immuniza-

tion

Geneva, Switzerland

May

4-5 GAVI Programme & Policy Committee Geneva, Switzerland

11-13 GAVI High Lever Review Panel (HLRP) Geneva, Switlzerland

Global Immunization News (GIN) October 2014

Page 18

May

12-14 2015 Technet Consultation TBD, Thailand

18-23 68th World Health Assembly

30-2May 9th International Conference on Typhoid and other invasive salmonellosis Bali, Indonesia

June

10-11 GAVI Alliance Board Meeting Geneva, Switzerland

15-19 SEARO Technical Advisory Group Meeting New Delhi, India (?)

July

20-24 GAVI High Lever Review Panel (HLRP) Geneva, Switzerland

October

7-8 GAVI Programme and Policy Committee Geneva, Switzerland

14-16 GAVI High Lever Review Panel (HLRP) Geneva, Switzerland

20-22 Meeting of the Strategic Advisory Group of Experts (SAGE) on Immunization Geneva, Switzerland

November

6-20 GAVI Independent Review Committee (IRC) for new proposals Geneva, Switzerland

December

2-3 GAVI Alliance Board Meeting Geneva, Switzerland

Page 19

WHO Regional Websites Routine Immunization and New Vaccines (AFRO)

Immunization (PAHO)

Vaccine-preventable diseases and immunization (EMRO)

Vaccines and immunization (EURO)

Immunization (SEARO)

Immunization (WPRO)

Newsletters Immunization Monthly update in the African Region (AFRO) Immunization Newsletter (PAHO) The Civil Society Dose (GAVI CSO Constituency) TechNet Digest RotaFlash (PATH) GAVI Programme Bulletin (GAVI)

Organizations and Initiatives American Red Cross Child Survival Agence de Médecine Préventive Africhol EpiVacPlus LOGIVAC Project SIVAC Centers for Disease Control and Prevention Polio Global Vaccines and Immunization Johns Hopkins International Vaccine Access Center Vaccine Information Management System JSI Africa Routine Immunization Systems Essentials Project IMMUNIZATIONbasics Maternal and Child Health Integrated Program (MCHIP) PAHO ProVac Initiative PATH Vaccine Resource Library Rotavirus Vaccine Access and Delivery Malaria Vaccine Initiative Meningitis Vaccine Project RHO Cervical Cancer

Sabin Vaccine Institute Sustainable Immunization Financing UNICEF Immunization Supplies and Logistics USAID Maternal and Child Health Integrated Program WHO Department of Immunization, Vaccines & Biologicals New and Under-utilized Vaccines Implementation ICO Information Centre on HPV and Cancer Immunization financing Immunization service delivery Immunization surveillance, assessment and monitoring SIGN Alliance Other Coalition Against Typhoid Dengue Vaccine Initiative European Vaccine Initiative Gardasil Access Program GAVI Alliance International Association of Public Health Logisticians International Vaccine Institute Measles & Rubella Initiative Multinational Influenza Seasonal Mortality Study TechNet-21 Vaccines Today

UNICEF Regional Websites Immunization (Central and Eastern Europe)

Immunization (Eastern and Southern Africa)

Immunization (South Asia)

Immunization (West and Central Africa)

Child survival (Middle East and Northern Africa)

Health and nutrition (East Asia and Pacific)

Health and nutrition (Americas)

Links

Global Immunization News (GIN) October 2014